10 Important Truths about Residential Treatment for Kids

Here are the truths about residential treatment for children that parents, teachers and social workers absolutely must know.

When Kids with Behavior Problems Need Residential Placement

Are you a parent who is considering placing your child in residential treatment and researching options? You might be at the end of your emotional rope with your child’s behavior and think residential placement is the answer.

Maybe your child is already in a residential treatment center, group home, inpatient in the hospital, or at a therapeutic boarding school and you are wondering about the type of care they are receiving.

Maybe you are a case manager or teacher who works with families whose kids have mental health issues and you need information about residential treatment to help these parents.

Read on for important truths about residential treatment that are important for you to know.

Why Residential Treatment for Kids?

Residential Treatment is a type of mental health care where kids live at a facility around the clock and receive supervision and care by trained staff.

Why would parents choose to place their child in residential treatment? Parents seek out-of-home placement when their child’s behavior is out of control. This can include violence, depression, suicidal thoughts, aggression, eating disorders, drug and alcohol use, actually out sexually and more.

As someone who has worked in the social work system, as well as placed my own child into residential treatment, these are the realities that I did not understand until after I had lived through the experience. I wish someone had been blunt and told me how the system works so I could be prepared and adjust my expectations.

Today, I’m doing it for you.

Residential Treatment for Kids: 10 Critical Truths You Must Know

Here are the important realities about facility treatment for children, youth, and teens that you must know.

1. Just because your child needs it, doesn’t mean they get it.

Every day I have parents who contact me and ask how they can get their child into residential treatment. They are in for a shock when they learn how difficult the process can be.

Just because your child needs residential care doesn’t mean they will get residential care. Spaces at facilities (called “beds”) might not be available, and if one is available that doesn’t mean you’ll be able to get someone to pay for it.

Residential treatment is incredibly expensive so it’s reserved for the most serious cases. While you might think your situation is serious (and I don’t disagree), the system might not agree that it is.

I once worked with a mom who had a child with attachment disorder. She woke up one night to find her son standing over her bed with a knife, threatening to kill her. When she tried to get him into residential care, the insurance company told her her son’s behavior “wasn’t bad enough to qualify”.

2. Your child can get the same treatment (or better) in the community.

Before my child went to residential treatment, I saw 24-7 care as the ultimate in mental health treatment. I figured that at a facility he would get lots of therapy.

I was shocked to learn that he actually got more therapy sessions (especially when he was in day treatment or intensive outpatient) at home than in a treatment center where he saw the therapist once a week.

If your child is so out of control that he’s dangerous to himself or others or your family simply cannot function anymore, considering out-of-home placements is the next right step. If you want your child placed so that he can get better mental health care, this might not be your best option.

3. You need to understand the different types of residential treatment.

There are different types of long-term treatment and each one offers different care and is paid for in a different way.

• Residential Treatment Facility (RTF) – This care is part of the services offered by the Department of Mental Health for the state where you live. Funding is typically provided by insurance, Medicaid, and the foster care system.
• Residential Treatment Center (RTC) – Residential Treatment Centers are typically funded by the court system and may be called Juvenile Detention (“Juvie”). A judge determines this placement and it’s paid for by the court.
• Group homes – Group homes are run by agencies and paid for by private or state funds. They have less supervision than a facility.
• Therapeutic boarding schools – These schools have a high level of supervision and most take kids with serious behaviors. Most are private pay.
• Military schools – Army schools offer intense structure and supervision. Some take only boys and some are co-ed. Most are private pay.
• Ranch schools – Kids live on a working ranch and go to school. These are private pay.
• Wilderness programs – These are short-term, private-pay programs that give adventure experiences in nature in order to provide kids with rehabilitation and improve behavior issues.

4. Kids learn bad behaviors in residential treatment.

When a child goes to residential, their behaviors are very serious. Parents are desperate or things are out of control things at home.

That means the child or teen is being placed with other kids who are all in the same boat. Parents, your child is going to learn negative behaviors from these other kids. It’s not ideal.

There’s also the fact that your child is living in an artificial environment. All people do better in families and communities. Living in a facility with paid staff isn’t normal or natural. Plus, staff turn-over is high.

Facilities do what they can to keep the kids entertained, which is often with healthy activities and outings but there are also times where they watch too much TV and movies (including ones you might not approve of at home), play too many video games and eat too much junk food.

If you are a parent and feel the residential staff is judging you, the truth is that they are. But in my experience most also do care and want to see your family succeed. Caring for kids with these extreme behavior issues is difficult for everyone involved.

5. Success rates aren’t great.

Success rates for residential treatment honestly aren’t that great. If you think a child will come out of residential treatment with massively improved behavior, you might be setting yourself up for heartbreak.

Some kids do improve, but many stay about the same and some get worse. Residential treatment is necessary when the child is a danger to himself or others, but it may not be the best for seeing behavior improvements.

6. Residential treatment isn’t punishment.

As a parent, if you’ve gotten to the place that you want your child in residential treatment, my guess is that you’ve been through hell. Your lives have been turned upside down with your child’s behaviors like aggression, stealing, lying, food issues, drug abuse, lack of respect, refusal to obey your rules and more.

You are probably exhausted, strung out, and fed up. By this point, you want to see your child or teen own up to his behavior and get some consequences. You might be in for a rude awaking when your child is taken on fun outings, new clothes are purchased for him, and he is given spending money or treats.

Residential treatment is meant to be healing and therapeutic, not punishment. When my child was in residential treatment, one of my biggest frustrations was seeing how easily he manipulated the staff and “worked the system”, behaviors that are very common in kids with attachment issues. I did what I could to talk to the staff about it, but ultimately I had to let it go because I couldn’t fix the problem.

7. You may have to put your child in foster care, revoke their adoption or have your parental rights terminated (TPR).

A cruel truth about the mental health system in the United States is that it’s simply not set up for parents who are trying to get their children intensive help. In order to pay for residential treatment, families are at times forced to make incredibly heart-breaking decisions including rescinding an adoption or having their rights terminated in order to force the state to pay for the child’s care.

Especially for parents who have adopted children with a trauma history, this feels like a cruel blow. These parents have taken a child into their family who was abused, and now it feels like the system is abusing the adoptive parents.

Depending on the state, children and teens are sometimes placed in foster care in order to fund treatment. This does not mean you must end your relationship with the child. If a child is placed into foster care, you still retain your parental rights.

If your situation has come to this point, I highly recommend hiring an attorney, educational consultant or advocate to assist you. You might think you can’t afford it, but you can’t afford not to.

8. You may have to pay child support.

If your child is placed into foster care to fund treatment, it’s quite possible you will be taken to court and expected to pay child support. Your wages may be garnished to fund your child’s treatment.

This happened to our family and besides being expensive, it was frustrating and humiliating. We had to go through the whole child support system even though we were in no way dead beat parents.

In you adopted your child from foster care and they have an adoption subsidy, in theory the payments should not be more than the adoption subsidy, and the subsidy can be used to fund treatment.

As much as parents are looking for an option for free residential treatment for their child, it doesn’t exist for many of us. If you have some financial means, you might also consider therapeutic boarding school or military school as as better option. You do have to private pay but scholarships, grants, and payment plans are available.

9. Just because a child gets in, doesn’t mean they stay in.

Whether it’s insurance, Medicaid, or state assistance, all funding sources will expect proof that the child needs this very expensive type of treatment. This gets tricky because treatment centers have to prove that the treatment is working and the child is improving, but not improving so much that they don’t need treatment anymore.

Depending on the type of care, this might be evaluated daily (such as for inpatient treatment), weekly (for day treatment or Intensive Outpatient or IOP) or every 28 or 30 days (residential).

When your child is in residential care, it’s possible that a time will come when he or she is sent home, even if you don’t feel ready or think your child is ready. Be prepared to advocate for them to keep the placement.

10. Kids can heal.

Despite the fact that this article shared a list of tough truths, there are bright spots and success stories. Our child was in residential treatment for a year and a half and he came home calmer and more mature. He learned to live within our family again and become a productive young adult. We still have our issues but we were able to function together as a family once again.

If your child is in residential treatment or you are considering it, please review these shocking truths carefully so that you can make the best decision for your family. While the process isn’t easy, know that other parents have walked the road before you and are here to offer support.

Have you placed a child in residential treatment or had trouble getting it? Share about your experience in the comments below.

Click here for a free PDF printable checklist of the 7 steps to take when your child needs residential treatment.

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